Do positive features of mental health change together with symptoms and do they predict each other?

In a previous study, it was found that several constructs derived from a positive definition of mental health had changed during psychotherapy. It remains unclear whether they change as part of a single process together with symptomatic change, as part of separate processes, or whether a change in one of the variables predicts change in another variable. Our objective in this study was to examine the relationship between the observed changes and to establish temporal precedence that constitutes a necessary condition for causation. Sixty-two clients who underwent psychotherapy in a naturalistic setting completed questionnaires at 5 time points throughout treatment. The change scores for each client in each of the variables were calculated. The correlations between the changes' scores were tested. To examine the time order, we used autoregressive cross-lagged modeling. A negative correlation was found between the symptoms change score and the happiness change score, r(60) = <0.53, p <.000. A positive correlation was detected between playfulness and happiness change scores, r(60) = 0.31, p =.014. Playfulness predicted subsequent levels of creativity, b = 0.66, t(121) = 2.1, p <.05. Honesty-humility levels predicted subsequent levels of creativity, b = 0.65, t(121) = 9.71, p <.001. The findings support the claim that the change in positive features of mental health is an independent process from symptomatic improvement. In addition, playfulness and honesty-humility temporally precede creativity, and thus might be part of a single change in a mental health construct that is positively defined.